Exercise type and settings, quality of life, and mental health in coronary artery disease: a network meta-analysis Toval, Ángel Bakker, Esmée A. Granada-Maia, Joao Bruno Esteban Cornejo, Irene Ortega Porcel, Francisco Bartolomé Exercise Mental health Cognition Brain Cardiovascular disease This article has been supported with the grant PID2020-120249RB-I00 and PID2023-148404OB-I00 funded by MCIN/AEI/10.13039/501100011033, and by the Andalusian Government (Junta de Andalucía, Plan Andaluz de Investigación, ref. P20_00124). Additional support was obtained by the CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Granada, Spain. E.A.B. has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement no. 101064851. A.T. has received funding from the Junta de Andalucia, Spain, under the Post-doctoral Research Fellows (ref. POSTDOC_21_00745). P.S.-U. is supported by the Spanish Ministry Universities (Margarita Salas fellowship). I.E.-C. is supported by RYC2019-027287-I grant funded by MCIN/AEI/10.13039/501100011033 and ‘ESF Investing in your future’. Background and Aims Individuals with coronary artery disease have poorer mental health, health-related quality of life (HR-QoL), and cognition compared with (age-matched) controls. Exercise training may attenuate these effects. The aim is to systematically review and meta-analyse the effects of different exercise types and settings on brain structure/function, cognition, HR-QoL, mental health (e.g. depression, anxiety), and sleep in patients with coronary artery disease. Methods A systematic search was conducted and a network meta-analysis compared (i) exercise types, high-intensity interval training (HIIT), HIIT + resistance (HIIT + R), moderate-intensity training (MIT), MIT + R and stretching-toning-balance training, and (ii) exercise settings, in-person and home-based. Results A total of 42 randomized controlled trials with a parallel group design were identified, of which 36 were included in the meta-analysis. Few studies included cognition (n = 2), sleep (n = 2), and none brain structure/function (n = 0). Most studies examined HR-QoL (n = 30), depression (n = 15), and anxiety (n = 9), in which outcomes were meta-analysed. HIIT + R, HIIT, and MIT were associated with improved HR-QoL vs. no exercise (i.e. usual care) [standardized mean difference, SMD: 1.53 (95% confidence interval 0.83; 2.24), 0.44 (0.15; 0.73), and 0.44 (0.20; 0.67), respectively]. In-person exercise was associated with larger and significant improvements [HR-QoL SMD: 0.51 (0.28; 0.74), depressive SMD: −0.55 (−1.03; −0.07), and anxiety symptoms SMD: −1.16 (−2.05; −0.26)] compared with no exercise, whereas home-based programmes were not significantly associated with improvements in these outcomes. Findings were robust in secondary (i.e. intervention duration and volume) and sensitivity analyses excluding high risk of bias studies. Conclusions Exercise training, especially in-person sessions, was associated with improved HR-QoL, depression and anxiety, independently of exercise type. However, this study raises concern about the effectiveness of home-based programmes in improving these outcomes. Study protocol was registered in PROSPERO (ID: CRD42023402569). 2025-02-25T08:27:52Z 2025-02-25T08:27:52Z 2025-01-15 journal article Angel Toval et al. Exercise type and settings, quality of life, and mental health in coronary artery disease: a network meta-analysis, European Heart Journal, 2025, ehae870, https://doi.org/10.1093/eurheartj/ehae870 https://hdl.handle.net/10481/102657 10.1093/eurheartj/ehae870 eng info:eu-repo/grantAgreement/EC/H2020/101064851 http://creativecommons.org/licenses/by/4.0/ open access Atribución 4.0 Internacional Oxford University Press